A Person with Type 1 Diabetes Asks You about Type 2

I often think those of us with type 1 and type 2 diabetes might be two people separated by a common disease. We’ve got the bad islets, you’ve got the insulin resistance. We both might be on insulin — though not always for y’all T2s — but our motivations seem very different. We’re both at odds with “the sugar,” but I don’t fell like I understand the type 2 experience very well at all. 90+% of diabetic folk have T2, but it seems like 90+% of the Diabetes Online Community (D-OC™) have T1.

Help me out with a little favor, if you would. Please tell me a little bit about T2.

  • As a T1 PWD, I take insulin to keep me from falling over dead. Why do T2 people take insulin? Do y’all use long-acting insulin (e.g., Lantus) or fast-acting juice (like Humalog)?* Maybe a bit of both?
  • How many times a day on average do y’all test? (I test about 10x daily.)
  • If you see a high BG, what do you do? Do you take some insulin? Go for a walk? Pop a pill? Wait for later when it comes down on its own? (Told you, I’m a total T2 newb here.)
  • Do T2 folks get hypoglycemia? Some of you must; I remember someone in my support group years ago talking about having a low on a cruise, and I helped a sweet older coworker who had the kind of sweat indoors that you can only get from low BG.
  • This may be the dumbest T2 question I’ll ask — you can decide for yourself, of course — but is T2 mostly about food? Diabetes Forecast is all about low-carb eating and “healthier” food choices. There are a billion “diabetic” cookbooks out there. Most endo reports I’ve seen have a heavy emphasis on “pre-meal” and “post-meal” readings. And so on.
  • How has T2 diabetes changed your life?
  • What do you wish people with type 1 diabetes knew about type 2?

Feel free to answer in the comments below, or write something on your own website and leave a link to it. I’m sincerely interested in learning about this “mysterious” type 2 diabetes that you have. :^)

* — Late last year, I very briefly helped with the diabetes care of an aging family member so that she could attend an event outside her nursing home. Basically, they weren’t going to let her go unless someone would test her blood sugar and administer some insulin. I volunteered. While her BG was quite good — and I was happy to have it in my meter — I have to say that I was a little freaked out giving her the 15-or-so units of Humalog all at once. (And it wasn’t tied to the amount that she ate either.) That’s almost half of my average daily insulin dosage, and I had to triple check the dosage. But I did it, and a couple hours later when I tested her again, everything was fine. Clearly, T1 and T2 people have different experiences with our shared disease.

Note: I moderate contributions from first-time commenters — even “long-time reader, first-time commenters” like you. Sorry. If you don’t see your comment show up right away, have faith that it will eventually appear when I get back to the Internets.

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2 Responses to A Person with Type 1 Diabetes Asks You about Type 2

  1. Bob P says:

    This is all my best understanding – I’m not a doctor or scientist.
    1) T2 is a progressive disease, and the treatment depends on where on the road one is. Once the beta cells fail, a T2 is insulin dependent in just the same way as a T1 is. Prior to the beta cells crapping out completely, some T2s may take long-acting insulin as sort of a support but don’t take fast-acting. Most T2s (me, for example) take other medications but not insulin, and some T2s are able to control BG with diet and exercise.
    2) The amount of testing depends on treatment plan and (alas) insurance. Many T2s test just once a day, watching trends in the fasting BG. I tend to test in the morning, and some other testing to watch for the effects of certain foods or if I feel funny.
    3) If my BG is high, exercise may be an option, if it’s not TOO high. Mostly, I wait.
    4) The likelihood of lows is dependent on treatment. Those taking insulin are subject to the same mysterious highs and lows as T1s.
    Some T2 meds bring a danger of lows, but metformin, the most common T2 med, doesn’t carry much risk. My lowest I know about was 71, and that was because I screwed up.
    To be cont’d. :)

  2. Bob P says:

    5. The core issue for Type 2′s in insulin resistance, a breakdown in the body’s ability to use the insulin available to escort sucrose into cells. Insulin resistance seems to develop for a number of reasons, but overweight and lack of exercise certainly contribute if other factors, incl. genetic factors, are present. This is why so many T2s (though not all) are overweight at diagnosis, why there’s such an emphasis on weight loss where needed. It’s likely that insulin resistance accounts for the large amount of insulin your relative needed: more insulin is needed when it’s underutilized. Some T2s on insulin require very large amounts of insulin.

    Pre-and post-testing, I think, is related to the necessity of a T2 who’s NOT on insulin (or at least a diligent one) to avoid big meal spikes, since they can’t bolus for them. I was taught that a reading 2 hrs after a meal should be no more than 40 pts higher than the pre-meal reading. I don’t do anywhere near enough of this kind of testing.

    Incidentally, the traditional view is that T2s’ beta cells eventually die is that they exhaust themselves trying to overcome the resistance. It’s my understanding that this view is now met with some suspicion.

    6. The answer here is gonna be pretty individual. For myself, a combination of my meds and the changes I have made have given me pretty good control – my last A1c was 6.0. So, I’m trying to live healthier to minimize the rate of progression, if I can, and to cut risks of heart disease and other conditions. So, in a sense, my struggle is more for the health of the future me than the current me.

    Making those changes has been hard: as I’ve written, I don’t know if my barriers are physiological, psychological, or just character flaws. But change is coming VERY slowly

    7. Bless you for asking. From my perspective, there are two things:
    a. Our diabetes is not our fault. It’s a bit sketchy for me to be making this claim: I’m a living embodiment of the T2 stereotype. But T2 is currently thought, I believe, to develop from genetic factors as well as lifestyle factors, as well as other factors not yet understood. As I’ve stressed, not all T2s are physically unfit at diagnosis, and there are many, many obese people that never develop T2. Yes, I must own my fat: but I didn’t ask for the genes or other factors any more than a T1 did.

    b. I see the assumption all the time, including repeatedly during one Diabetes Social Media Advocacy session, that the response of a newly-diagnosed T2 is either/or: either they take change seriously and get healthy, or they don’t and get sicker. As I said above, I struggle. And I think there are many people like me who are doing the best they can, but just can’t make the dramatic turnaround. Think of how complicated balancing the intake of insulin is, and how many factors are involved, and the impossibility of even knowing about them all, let alone accounting for them all perfectly. Is it really likely that weight loss is always the simple eat less/exercise more formula? Bottom line: just because I’m not getting skinnier or running marathons doesn’t mean I’m not doing the best I can with what I am.

    I’m nervous, because what I’ve written kinda looks like I know way more than I actually do. If I’ve erred, I hope you get other comments to point that out.

    Great questions: thanks for asking them. :)

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